Rebecca Osborn
Charge Nurse, HM Prison Swansea
(Accord Healthcare case study)
A new way to deliver treatment for opioid overdose is saving the lives of newly discharged prisoners and those still in custody, says a substance misuse nurse at HM Prison Swansea.
Rebecca Osborn is dedicated to changing — and saving — lives. As a Charge Nurse working in the area of substance misuse at HM Prison Swansea, she looks after the care and wellbeing of all prisoners who have addiction issues with drugs and alcohol.
Rising opioid addiction and deaths
“It’s my job to deliver the treatment interventions needed by these prisoners,” Osborn explains. “It’s a wonderful and frightening responsibility and, in terms of my nursing career, the biggest thing I’ve ever done.”
Most prisoners with addiction issues already have them when they arrive at HM Prison Swansea, notes Osborn. However, an increasing number develop issues while they are in custody because of the amount of illegal drugs circulating in UK prisons, including opioids and synthetic opioids. Because of this, drug-related deaths of prisoners and former prisoners are on the rise in the UK.
Normalising and simplifying the delivery of medication
If someone overdoses on opioids or synthetic opioids, the result can be fatal; although timely administration of an opioid antagonist can bring them back from the brink, reversing the opioid overdose. However, at HMP Swansea, the treatments were delivered by injection — and, as Osborn discovered, this was a significant barrier to its use.
Timely administration of an opioid
antagonist can bring them back from
the brink, reversing the opioid overdose.
First, prison officers were wary of carrying medication around with them in case they administered the treatment incorrectly. Second, prisoners who were being discharged back into the community would often refuse to take doses of treatment home with them for their family or friends to administer. “It was delivered in a big yellow syringe,” explains Osborn. “That was like a sign saying: ‘I’m a drug addict.’ There’s a stigma attached to it.”
So, three years ago, Osborn reached out to pharma company Accord Healthcare to see if they could if they could offer training and support in normalising and simplifying the administration of opioid antagonist treatments. “They came up with an unobtrusive nasal spray version,” she says. “Now, a prisoner who has overdosed can be given treatment easily, and the results can be instantaneous, depending on the amount of drugs they have taken.”
Training prisoners in overdose awareness and treatment
To ensure a successful roll-out, Osborn started an innovative pilot programme, which involved training prisoners to recognise the signs of overdose and then administer the opioid antagonist themselves. This sounds like a risk, admits Osborn — yet the opioid antagonist is completely safe and cannot be abused, which means that prisoners can be given doses to keep in their cells to use in emergency situations. “At first, prisoners were stunned that we were giving them this responsibility,” she says. “When we explained that we saw them as mentors who could use the medication to save the lives of their fellow prisoners, they understood our rationale.”
Using and delivering the opioid antagonist in this way has already prevented prisoner deaths. “When one prisoner overdosed soon after arriving in reception, a mentor quickly obtained the medicine and saved his life,” says Osborn. “In fact, the last death from an opioid overdose at HMP Swansea was more than 24 months ago. My hope is that other prisons will look at what we’ve achieved and adopt it as standardised practice because it’s working so well.”
